Pubdate: Mon, 07 May 2001 Source: Guardian Weekly, The (UK) Copyright: Guardian Publications 2001 Contact: http://www.guardianunlimited.co.uk/GWeekly/front/ Details: http://www.mapinc.org/media/633 Author: Sarah Boseley BITTER PILL A British Academic Claims That Prozac, One Of The Bestselling Drugs Of All Time, Can Drive People To Suicide, Even If They Aren't Depressed - Did His Views Cost Him A Job In Canada? David Healy was looking forward to moving to Canada. For the British psycho-pharmacologist, author of the definitive history of anti-depressant drugs, the invitation to take up a post at the University of Toronto made absolute sense. Apart from the academic advantages, his claims that the drug Prozac and its copycat sisters can make some people commit suicide were taking him to the United States increasingly often to testify on behalf of bereaved families against the drug companies. It wasn't to happen. Healy's move across the Atlantic, closer to the field of battle over some of the bestselling drugs of all time, has been scuppered in what some see as the latest skirmish in a dirty war to stop him and others from speaking out. The stakes are huge. The pharmaceutical group Eli Lilly made $2.6bn from Prozac last year alone and is pulling out all the stops to register the drug for new uses now that its patent is at an end. It has just succeeded in getting it renamed and repackaged as Sarafem, for severe premenstrual tension, which will keep the profits rolling in until 2007. If Healy is right, there is a risk that a minority of people on Prozac will take their own lives. He calculates that a quarter of a million people worldwide have tried to commit suicide because of Prozac, and that 25,000 have succeeded. For the manufacturers of the SSRIs (selective serotonin re-uptake inhibitors, as this class of drug is called) Healy's work is enormously damaging. Eli Lilly claims that there is absolutely no evidence of a link between Prozac and suicide, but in academic circles Healy, who is director of the North Wales department of psychological medicine, has a high reputation. Two years ago he began to be courted by the Centre for Addiction and Mental Health (CAMH) at Toronto University. He spent three days there in July 1999. Afterwards Paul Garfinkel, the chair of the department, wrote an appreciative letter, looking forward to the chance to "discuss more specifically the arrangements for you in Toronto". On January 28 last year Sidney Kennedy, another professor in the department, wrote with full details of the position Healy was being offered. Last August the formal offer was made by David Goldbloom, physician in chief at CAMH. Healy formallyaccepted it in September. Then in November Healy was invited to speak at a two-day conference at CAMH. Everything seemed to be going smoothly. He was urged by Goldbloom to give one month's notice instead of three months'. He was told: "We need to get you here within weeks rather than months." The talk on November 30 appeared to go down well. The same talk received acclaim in the US a few days later and again earlier this year in Paris. But in Toronto Goldbloom showed signs of distress. According to Healy, Goldbloom was worried that the main thing people would take away from his talk was the claim that Prozac can cause suicide. Within a few days Healy received an email from Goldbloom, saying he had something urgent to discuss. Goldbloom finally broke the news by email on December 7. "Essentially, we believe that it is not a good fit between you and the role as leader of an academic program in mood and anxiety disorders at the centre and in relation to the university," he said. "This view was solidified by your recent appearance at the centre in the context of an academic lecture. While you are held in high regard as a scholar of the history of modern psychiatry, we do not feel your approach is compatible with the goals for development of the academic and clinical resource that we have." The decision to rescind the job offer, apparently within hours of a talk on the dangers of Prozac, has caused uproar in Canadian academic circles because CAMH has been funded by Eli Lilly to the tune of more than $1.5m in recent years. To the Canadian Association of University Teachers, what has happened to Healy is "an affront to academic freedom in Canada". It has hit a nerve that is already raw. Last year an international furore broke out over Nancy Olivieri, the Toronto-based scientist who broke a confidentiality agreement with the pharmaceutical company Apotex and published research concerning the level of toxicity of its drug Deferiprone for children suffering from the hereditary blood disease thalassaemia. At one point the Hospital for Sick Children, part of Toronto University, tried to sack her. James Turk, executive director of the association, draws a parallel with the treatment of Healy. "This is every bit as serious as the Olivieri case - and that's a very serious one," he says. "We can't see how this can be other than a serious erosion of academic freedom." Turk says the wording of Goldbloom's email is telling. "Development is a euphemism here for fundraising. I read that as meaning, 'Your appointment will make it more difficult to raise the money that we need to pursue our programmes.'" The crucial question is what - or who - persuaded CAMH to change its mind. Healy's views are well known. But what Goldbloom and his colleagues may not have appreciated - until someone told them - was the significance of employing an academic with such views in a world where research is heavily reliant on drug-company grants. That someone, says Healy, may have been Charles Nemeroff, a professor of psycho-pharmacology at Emory University in Atlanta who has strong links, including shareholdings, to Eli Lilly, GlaxoSmithKline and Pfizer, the three companies which make SSRIs that are, or have been, involved in court cases in which Healy has been an expert witness. Nemeroff was at the Toronto meeting, but did not stay for the second day. Instead he went to another gathering in New York, where, says Healy: "My understanding is that he was saying I had lost my job." That was a week before Healy knew it himself. Nemeroff has made no secret of his hostility to Healy's work. In July last year, at the British Association for Psychopharmacology, Healy says that Nemeroff berated him over a study he had carried out of the effects of one of the SSRIs on healthy volunteers. Two out of 20 became suicidal. "He began, as far as I can remember, by stating that I had no right publishing material like that," says Healy. "I mentioned that it was all good, clear-cut science, and that there were other findings in the literature which backed this up. He said it would be bad for my career to get involved in all this - that in the course of the previous few weeks he had been approached on five occasions to see whether he would testify in legal actions against me." Nemeroff's office refers press calls to Nina M Gussack, a Philadelphia lawyer, who has defended Eli Lilly in Prozac litigation. She denies that he orchestrated the loss of Healy's job, but she says that university officials did ask his opinion of Healy's science. The University of Toronto denies that the Prozac issue was connected with the change of heart over Healy. Asked what "not a good fit" meant, Garfinkel says: "It means that the search committee had in its internal deliberations reasons to feel that there were going to be better opportunities for our mood programme." But Healy says the attitude to him of everybody at Toronto was very positive until the talk, and he was even asked to sit on an interview panel for a post that would be under his supervision when he moved to Canada. Eli Lilly denies having exerted any influence. "Lilly was not involved in any decision to withdraw the job offer to Dr Healy as Lilly does not get involved in employment matters of its grant recipients," it says in a statement. Any suggestion that what happened would have a bearing on future court cases "would be purely speculation, and we don't comment on speculation". However, Andy Vickery, of Vickery and Waldner, a law firm based in Houston, Texas, which has retained Healy as an expert witness in several cases concerning SSRIs, says he has no doubt that what happened to Healy was connected with the litigation. Healy, he says, is a problem for those who want to "perpetuate the myth that there's no problem with these drugs".